HomeMy WebLinkAboutMortgage_Johnson (12),14��Pq STATEMENT OF MORTGAGE OR CONTRACT
a��• y" INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
=�� VALUATION State Form 43709 (1-90) Prescribed by the
�,a,• State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county ��here th
property is located during the 12 months before May 11 of the year tf �e deduc n
is to be effective. See reverse for additional instructions and qualification
Applicant
li
on
Key Number/Le�l Description
� i� -0337�- o�
Assessed value of real property as Morti
of March 1, current year as of
If no, what is his/her exact share or interest?
JUL 15 1996
�/ /,�• ��
W�'"ri'`J ...nrroR
Record
No.
Indebtedness unpaid I Is the applicant the sole legal or
;p�,�cearr equitable owner? O yes O no
If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contract seller
of mortgagee or contract seller
Name of Assignee or other owner or
of Mortgage.
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? � yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
,s 98 ,�o� ,s�
Signature
�-Q-9y �3-�
, ��e2 � oba ��" I ��
Eb
�S/_-��-bl I..��Q'07- p��
Secretary of Board �� eview �D�te.de Oq
,�OD,i— jP � P P P
:„.
i
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
s was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
ture (owners full name) Person authorized by duly executed Power of Attorney or
h�.�. .(� ti n�. , by IC 6-1.1-12-.07).
Full Resident Address of Aplicant
- � 0 '� P . P,�![..n�.c
Address of Authorized Person